Cited by 99Thyroid Disorders and TreatmentsThyroid and Parathyroid SurgeryDrug Solubulity and Delivery Systems

Switching levothyroxine from the tablet to the oral solution formulation corrects the impaired absorption of levothyroxine induced by proton-pump inhibitors

Vita, Roberto, Saraceno, Giovanna, Trimarchi, Francesco, Benvenga, Salvatore·2014·The Journal of Clinical Endocrinology & Metabolism

Abstract

CONTEXT: Proton-pump inhibitors (PPIs) impair tablet levothyroxine (LT4) intestinal absorption by increasing the gastric pH and decreasing LT4 dissolution in the stomach. OBJECTIVE: The purpose of this study was to verify whether a liquid formulation of LT4 would correct LT4 malabsorption induced by PPIs. DESIGN: This was a prospective observational cohort study. The study was conducted from 2012 to 2013, and the mean duration of the follow-up was 23.7 ± 11.9 weeks. SETTING: The study was conducted in a tertiary university hospital outpatients clinic. PATIENTS: Upon informed consent, we recruited 24 consecutive adult patients (18 women and 6 men), who took LT4 for replacement (n = 14) or suppressive purposes (n = 10) and who had absorption of tablet LT4 impaired by PPIs. INTERVENTION: The 24 patients were switched from the tablet to the oral solution LT4 at the same daily dose. MAIN OUTCOME MEASURES: Significantly lower mean TSH levels were seen with the oral solution than with the tablet as were significantly greater rates of serum TSH less than or equal to the specified cutoff values (replacement [REP] group) or ≤ 0.10 mU/L (suppressive [SUP] group) with the oral solution than with the tablet. RESULTS: Serum TSH was lower with the oral solution than with the tablet formulation (REP group, 1.7 ± 1.0 mU/L vs 5.4 ± 4.3, P < .0001; SUP group, 0.1 ± 0.3 mU/L vs 2.1 ± 2.7, P < .0001). In the REP group, the rate of TSH values of ≤ 4.12 or ≤ 2.5 mU/L was 29 of 30 (96.7%) or 24 of 30 (80.0%) postswitch but only 17 of 36 (47.2%) or 9 of 36 (25.0%) preswitch (P < .0001). In the SUP group, the rate of serum TSH values of ≤ 0.10 mU/L was 26 of 35 (74.3%) postswitch but 0 of 22 (0%) preswitch (P < .0001). CONCLUSIONS: These data demonstrate the continued absorption of liquid LT4 despite the increased gastric pH due to PPI therapy.

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Crossref · 10.1210/jc.2014-2684

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  • In a prospective, pre-post study of 24 hypothyroid patients who took PPIs, with mean follow-up 23.7 weeks, TSH levels were significantly lower in the solution group than in the tablet group (1.7 ± 1.0 vs 5.4 ± 4.3 mU/L, P < .001).

    “Vita et al conducted a prospective, pre–post study of 24 hypothyroid patients who took PPIs (197). The mean duration of follow-up was 23.7 weeks. TSH levels were significantly lower in the solution group than in the tablet group (1.7 ± 1.0 vs 5.4 ± 4.3 mU/L, P < .001).”

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Authors
Vita, R., Saraceno, G., Trimarchi, F., & Benvenga, S.
Affiliations
University of Messina (IT)
Corresponding author
Vita, Roberto
Venue
The Journal of Clinical Endocrinology & Metabolism
Published
2014-12
Volume
99
Issue
12
Pages
4481-4486
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
OpenAlex
W2055123669
Cited by
99
References
28
Citations by year
2026: 3 · 2025: 5 · 2024: 5 · 2023: 10 · 2022: 8 · 2021: 13 · 2020: 9 · 2019: 11 · 2018: 10 · 2017: 10 · 2016: 9 · 2015: 6
FWCI
6.70
Type
journal article
Language
en
Open access
closed
Locations
  • The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Drug Solubulity and Delivery Systems
Keywords
levothyroxine, oral solution, tablet formulation, proton pump inhibitors, drug-drug interactions, thyroid hormone replacement, thyroid suppression therapy, serum TSH, thyroid function monitoring, gastric pH, drug formulation switching, antithyroid drugs
MeSH terms
Adult, Aged, Drug Interactions, Female, Humans, Intestinal Absorption, Male, Middle Aged, Prospective Studies, Tablets, Thyrotropin, Thyroxine, Cohort Studies, Pharmaceutical Solutions, Proton Pump Inhibitors

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